WorksheetsPharmacology 2 Local Anesthetics/ Sympatholytics
Total questions: 91
Worksheet time: 46mins
Name
Class
Date
1.
The pre-ganglionic sympathetic nerve fibers release what at the automatic nerve bundle?
a)
Substance P
b)
acetylcholine
c)
Norepinephrine
d)
Calcium
2.
Which of the following is a non-selective alpha antagonist?
a)
Yohimbine
b)
Prazosin
c)
Doxazocin
d)
Phentolamine
3.
Which of the following medication has the highest/most effective β1 selectively?
a)
Propranolol
b)
Esmolol
c)
Atenolol
d)
Carvedilol
4.
Mr. Johnson is 85 years old and has BPH, he has not seen the doctor in 2 years recently he has issues with syncope due to orthostatic hypotension, which medication would he be taking?
a)
Doxazosin
b)
Propranolol
c)
Phentolamine
d)
PO Nitroglycerin
5.
Bobby is a brand new SRNA and did not know what phenylephrine was but flushed into a blown IV; what is the treatment medication to give?
a)
Yohimbine
b)
Tolazoline
c)
Phenoxybenzamine
d)
Phentolamine
6.
Which of the following is not a symptom of pheochromocytoma
a)
Increase Blood pressure
b)
Increase Anxiety
c)
Decrease Heart Rate
d)
Decrease Weight
7.
Which of the following medication irreversibly binds to α1 and α2 receptors, and is used as a long term treatment of pheochromocytoma?
a)
Terazosin
b)
Tamsulosin
c)
Phentolamine
d)
Phenoxybenzamine
8.
What statement regarding the clinical use of β-Blockers is false
a)
Treatment of essential hypertension
b)
Management of angina pectoris
c)
Suppression of cardiac dysrhytmias
d)
Provide sympathetic nervous system activity
9.
Mrs. Jones suffers from severe asthma attacks and is hospitalized at least 3 times a month for severe wheezing which beta blocker should be prescribed for her to lower her blood pressure at home?
a)
Propranolol
b)
Nadolol
c)
Esmolol
d)
Atenolol
10.
True or False propranolol decrease clearance of amide local anesthetics due to decreased hepatic blood flow & inhibition of liver metabolism
a)
True
b)
False
11.
Which statement regarding β1 cardio-selective Blockers is true
a)
Poorly suited for asthma patients
b)
Increases chronotropic effects, decrease dromotropic and inotropic
c)
Ideal medication to treat essential hypertension because there is no vasodilatory effects on peripheral blood vessels
d)
Increase myocardial oxygen demand and myocardial ischemia
12.
Which statement regarding β blockers is False
a)
The larger the dose of a cardioselective beta blocker the more likely it will become non-selective
b)
Beta blockers are reversible and competitive antagonist
c)
Chronic administration of beta blockers is associated with an increase in B-adrenergic receptors
d)
Preoperative beta blocker should be held to maintain desirable drug effects and to avoid the risk of sympathetic nervous hyperactivity
13.
Does propranolol have a drug interaction with local anesthetics? What happens?
a)
Yes; Increase in metabolism of local anesthetics
b)
Yes; Decrease in metabolism of local anesthetics
c)
Yes; Decrease in the clearance of local anesthetics
d)
No; nothing
14.
John is a 28 year old coming into the OR with a femur fracture have a car accident; He admits to sorting cocaine and drinking alcohol prior to driving; He has received pain medication and 2 liters of crystalloids what medication is ideal to treat the B/P: 174/89
a)
Esmolol
b)
Nitroglycerin
c)
Hydralazine
d)
Propranolol
15.
What is a good dose of Esmolol prior to intubation, to blunt the laryngeal stimulation response?
a)
150mg
b)
500mg
c)
10 mg/kg
d)
Dont give Esmolol prior to intubation
16.
Which of the following is NOT a contradiction to β blockade
a)
Sinus or AV node dysfunction, heart block
b)
Hypotension
c)
Severe reactive airway disease
d)
Class 1 heart failure
17.
Which statement regarding local anesthetics is false
a)
Local anesthetics are weak acids
b)
Local anesthetics produce a reversible conduction blockade along central and peripheral nerve pathways
c)
An increase in concentration produces a increase blockade of sensory, motor and autonomic nerve
d)
Local anesthetics cause a loss of sensation in a discrete region of the body
18.
Resting membrane potential is determined by what?
a)
amount of sodium channels along the nerve
b)
Potassium concentration differential across nerve call membrane
c)
Sodium permeability through ionized channels
d)
size of the nerve determines resting membrane potential
19.
What are the three chemical structures employed by local anesthestics
a)
Benzene Ring; Ester or amide chain; Secondary or Tertiary amine
b)
Lipophilic; Hydrophilic; Static chain
c)
Extra cellular; inner cellular; ester amide bond
d)
acid section; basic section; neutral section
20.
True or False: Local anesthetics block sodium channels, but can also block potassium channels at higher doses
a)
True
b)
False
21.
What portion of the local anesthetic is needed to bind to the receptor? Which is needed to penetrate the nerve
a)
Charged Salt; Un-charged base
b)
Charged Base; Un-charged salt
c)
Sodium link to amide group; Potassium link to benze ring
d)
Ionic charged lipophilic; and non charge hydrophilic
22.
Esmolol can be used in all of the following except
a)
Cardiac-cocaine toxicity
b)
Suppression of cardiac dysrhythmias
c)
Long-term management of essential hypertension
d)
Thyrotoxicosis
23.
Which statement is false about Metoprolol?
a)
β1 selective at higher dosage non-selective
b)
Half-life 3-4 hours
c)
Suited for COPD/ PVD pts due to the lack of β2 activity
d)
Low first pass metabolism
24.
What number is the best time for local anesthetics to enter the nerve membrane
a)
1
b)
3
c)
4
d)
5
25.
Which member of local anesthetics is lipophilic
a)
Ester chain
b)
Amide Bond
c)
Benzoic acid derivative
d)
Secondary or tertiary amine
26.
Of the local anesthetics listed which on is not a Amide
a)
Lidocaine
b)
Bupivacaine
c)
Procaine
d)
Prilocaine
27.
At pH 7.4 what is the physiological state of most local anesthetics
a)
Charged ionized
b)
Charged unionized
c)
Uncharged ionized
d)
Uncharged unionized
28.
Which of the following increases the potency and toxicity of local anesthetics
a)
Increasing the alkyl substitution and lengthening the chain
b)
Halogenating the local anesthetic
c)
Instilling only R enantomers
d)
Shortening the amide or ester chain
29.
True or False: Local anesthetic blockade depends on the the status of the sodium channel receptor
a)
True
b)
False
30.
Which of the following is not a susceptibility that local anesthetics depend on?
a)
Presence of myelin
b)
Size of nerve fiber
c)
Position of fiber in nerve bund
d)
The length of the nerve fiber
31.
What is the correct order of local anesthetic affect to first order neurons?
a)
C, B, Aδ, Aβ, Aγ, Aα
b)
B, C, Aδ, Aγ, Aβ, Aα
c)
B, C, Aα, Aβ, Aγ, Aδ
d)
Aα, Aβ, B, C, Aδ, Aγ
32.
In a nerve bundle what is the most exterior nerve fiber?
a)
B
b)
C
c)
A-alpha
d)
A-Delta
33.
How many nodes of Ranvier are needed to be covered with local anesthetic to prevent a nerve impulse jump
a)
One to two
b)
Two to three
c)
Three to Four
d)
Just use epi
34.
Toxicity of local anesthetics can be decreased by what classification of medication
a)
Vasodilators
b)
Vasoconstrictors
c)
More Local Anesthetics
d)
Beta blocker
35.
Which class of local anesthetics is more likely to cause systemic toxicity
a)
Ester
b)
Amides
c)
Alkalized Amides
d)
Hydropyridinized Esters
36.
Which is NOT a method of metabolism for amide and ester local anesthetics
a)
Ester hydrolysis
b)
Pulmonary metabloism
c)
Catechol-O-methyltransferase
d)
N-dealkylation and hydrolysis
37.
Mr. Smith just had a epidural placed under ultrasound guidance and confirmed in right place; local anesthetic is injected into the catheter. He starts having a metallic taste in his mouth, feeling light headed, and dizzy. What has happened
a)
Local anesthetic toxicity
b)
Epidural is placed in the wrong location
c)
Medication interaction
d)
Mr. Smith needs to grow a pair and stop whining
38.
Ester local anesthetics produce more allergic reactions due to?
a)
Plasma pseudocholinesterase prolonged metabolism
b)
Preservatives
c)
Paraaminobenzoic acid (PABA)
d)
Local anesthetics do not cause allergic reactions
39.
Who is more likely to experience local anesthetic toxicity
a)
Pregnant patient
b)
Healthy 18 year old
c)
Obese
d)
Elderly patient with appropriate dose reduction
40.
Which system is MOST effected by higher doses of Lidocaine
a)
Central Nerve System
b)
Cardiovascular
c)
Hepatic system
d)
Genitourinary tract
41.
If the CC/CNS toxicity ratio is low what does it imply?
a)
A safe local anesthetic
b)
A reduced safety margin for local anesthetic
c)
Higher toxicity of Cardiovascular muscles versus nerves
d)
Plasma concentration need to be lower than 20 μg/ml
42.
Which local anesthetic causes myocardial contractility without arrhythmia
a)
Bupivacaine
b)
Etidocaine
c)
mepivacaine
d)
lidocaine
43.
What are the agents in local anesthetics that inhibit microbial growth but can cause allergic reactions
a)
Methylparaben
b)
Methlylene blue
c)
Methlynatedparabostatin
d)
Bacteriostatic saline
44.
True or False: Any type of local anesthetic can be pushed into a spinal or epidural catheter/ sygrine
a)
True
b)
False
45.
What anatomical location is more likely to have higher blood local anesthetic levels
a)
Intercostal
b)
Caudal
c)
Epidural
d)
Brachial Plexus
46.
Do local anesthetics (not related to spinal injection or epidural injections) depend on weight, age, or both
a)
weight
b)
age
c)
both
d)
where did you find this
47.
Which local anesthetic has the fastest onset?
a)
2-Chloroprocaine
b)
Lidocaine
c)
Ropivacaine
d)
Mepivacaine
48.
What is the maximum dose of Chloroprocaine without epi
a)
700 mg
b)
800 mg
c)
80 mg
d)
70 mg
49.
Which is the only local anesthetic that causes vasoconstriction
a)
Lidocaine
b)
Cocaine
c)
Ropivacaine
d)
Bupivacaine
50.
Robert is a 42 year old male that has abused cocaine for 20 years what is an expected clinical coronary finding
a)
Dilated LV; with vasospasms
b)
Hypertension and coronary vasospams
c)
Hypotension; peripheral vasoconstriction
d)
Right sided heart failure with pulmonary vasoconstriction
51.
Which local anesthetic should you not use in liver failure
a)
Cocaine
b)
Lidocaine
c)
Ropivacaine
d)
Tetracaine
52.
What is the appropriate dose of lidocaine with and without epi?
a)
450mg -500mg {6mg/kg} max without epi; 8 mg/kg with epi
b)
500-700 mg max without; 7 mg/kg with epi
c)
450-500 mg max {or 4mg/kg} without epi; 7 mg/kg with epi
d)
Give 7 mg/kg for both with and without epi
53.
Dan is an 121 kg patient calculate the total lidocaine with epi dose
a)
847 mg
b)
500 mg
c)
842 mg
d)
846 mg
54.
Which medication should not be used in parturient patient population to avoid fetal ionizing trapping
a)
Chloroprocaine
b)
Mepivancaine
c)
Bupivacaine
d)
Ropivacaine
55.
What is a major issue with prilocaine use
a)
Ester allergic reaction
b)
byproduct of methemoglobinemia
c)
Long duration of action
d)
Multiple active metabolites
56.
True or false : Bupivacaine has a very high CV/CNS ratio making it a very safe medication
a)
True
b)
False
57.
Which medication is ideal for Bier Block or IV regional anesthesia
a)
lidocaine
b)
bupivacaine
c)
procaine
d)
tetracaine
58.
What is the max dose of bupivacaine with epi
a)
200mg
b)
175mg
c)
225mg
d)
350mg
59.
What is the treatment for methemoglobinemia? what is the maximum dose of the treatment?
a)
Methane Blue; 3% MAC
b)
Methylene Blue; 7.5 mg/kg
c)
Methylene blue; No max
d)
Methylene blue; 2.5 mg/kg
60.
What medication should be promptly administered in local anesthetic toxicity? What dose?
a)
Vasopressin; 0.5 unit per kg
b)
Intralipids; 0.25-0.5 ml/kg/hr
c)
Calcium channel blockers; depending on class
d)
Esmolol; 0.5 mg/kg
61.
What is the maximum dose of ropivacaine for an epidural catheter
a)
250mg
b)
200mg
c)
180mg
d)
220mg
62.
Mrs. Rodriguez comes in for a gangrenous toe amputation, she weighs 100kg; the surgeon what to do local infiltrates of lidocaine, why is that a bad idea?
a)
The total amount needed will exceed max valves
b)
The acidotic environment with render the local anesthetic useless
c)
Mrs. Rodriguez has to have heart problems, so we cannot use LA
d)
Lidocaine is the wrong choice something longer acting will provide better coverage
63.
What is the optimal dose of epi to add to local anesthetics
a)
4 mcg/ml
b)
15 mcg/ml
c)
6 mcg/ml
d)
5 mcg/ml
64.
True or False: Test doses are not considered part of the total anesthetic dose
a)
True
b)
False
65.
What anatomical location is more likely to cause CNS toxicity with minimal intra-arterial injections
a)
Chest and abdomen
b)
Head and neck
c)
Shoulders and clavicle
d)
Scapula and thoracic spine
66.
What are some things a practitioner can do to avoid local anesthetic toxicity
a)
Inject 5 cc at a time
b)
Inject slowly
c)
Carefully aspirate
d)
All answers are correct
67.
What is the duration of lidocaine without epi
a)
240 minutes
b)
200 minutes
c)
180 minutes
d)
120 minutes
68.
What is the duration of action for bupivacaine with epi
a)
4 Hours
b)
3 Hours
c)
6 Hours
d)
8 Hours
69.
What is the duration of chloroprocaine without epi
a)
30 minutes
b)
40 minutes
c)
120 minutes
d)
90 minutes
70.
Where does the amine (hydrophilic) portion of local anesthetics work at?
a)
Inside the cell membrane on the α sub-unit of the sodium ion channel H gate
b)
Inside the cell on the potassium channel
c)
Outside on the sodium receptor
d)
Binding allosterically to the outside portion of the sodium ion channel
71.
What statement regarding α2 agonist is false?
a)
Decrease release of presynaptic norepinephrine via negative feedback system
b)
Block salivary gland secretion
c)
Mediates sedative and mild analgesic properties
d)
Aburpt withdrawal of α2 has mild effects
72.
Dexmedetomidine has how much affinity for alpha 2 to alpha 1? Clonidine has how much affinity for alpha 2 to alpha 1?
a)
1600:1 ; 460:1
b)
250:1 ; 550:1
c)
1600:1 ; 220:1
d)
700:1 ; 220:1
73.
What amount of precedex is needed to induce a paradoxical hypertensive in Nathan a 70 kg patient?
a)
75 mcgs over 1 minute
b)
150 mcgs over 3 to 5 minutes
c)
10 mcgs over 3 to 5 minutes
d)
70 mcgs over 3 to 5minutes
74.
Señora Juantia takes clonidine daily, but her lazy grandson never picked up her prescription what medication should the EMS give in route to the hospital
a)
Esmolol
b)
Labetaol
c)
Metropolol
d)
Phentolamin
75.
Which statement about Calcium Channel blockers is true
a)
Blockade occurs only through extra cellular blockade of l type voltage gated Ca channels
b)
There are four classes of CCB's phenylalkylamines, dihyfropyridens, benzothiazepines, and benzylisoquinolinium
c)
CCB work at the Ca l type voltage gated channel affecting the flow of Ca in myocardial and vascular smooth muscles
d)
CCB cause vasoconstriction, especially in the periphery
76.
Mrs. Smith is having new onset ST depression in lead III and AVF under general anesthesia -what medication is ideal for treatment
a)
Esmolol
b)
Verapamil
c)
Labetalol
d)
Nicardipine
77.
Howard is a 56 year old patient going in for hip replacement and has controlled hypertension with oral amlodipine. During maintenance his pressure soars to 165/85 his heart remains 67, you just gave fentanyl 50 mcgs 4 minutes ago. What medication would you give?
a)
Labetaol
b)
Nicardipine
c)
Hydralazine
d)
Diltiazem
78.
Which class of CCB (calcium channel blocker) works on the inside of the L voltage gated Ca 2+ channel
a)
Phenylalklamine
b)
Benzothiazipines
c)
Dihydropyridines
d)
Diltiazem
79.
Which of the following is not a contraindication for Calcium Channel blockers
a)
Hypovolemia
b)
Atrioventricular heart blocks 2nd, 3rd
c)
Left Ventricular dysfunction
d)
Tachycardia dysrhythmia
80.
Which medication is going increase in effect due to Calcium channel blockers
a)
Vecuronium
b)
Labetaol
c)
Tylenol
d)
Glycopyrrolate
81.
What class of medication is most effective in treatment of hypertension
a)
ACE inhibitors
b)
CCB
c)
Beta-blockers
d)
Alpha-1 antagonist
82.
Following treatment of ACE inhibitors what amino acid levels are expected to rise?
a)
Prostaglandins
b)
Norepinephrine
c)
Bradykinin
d)
Aldosterone
83.
Which of the following is not a mechanism of action of ACE inhibitors
a)
Decrease angiotensin II
b)
Increase Bradykinin
c)
Decrease LDL levels
d)
Increase secretion of Aldosterone
84.
Jackie is a 85 year Chronic renal failure patient her GFR is 25, what medication would you not give to her
a)
Enalapril
b)
Esmolol
c)
Metropolol
d)
Propofol
85.
What is the mechanism of action of PDE5 inhibitors
a)
Release calcium into the smooth vasculature
b)
Inhibit the breakdown of cGMP in vascular smooth muscles
c)
Accelerate the breakdown of cGMP in the vascular smooth muscle
d)
Inhibit Protein kinase C from degradation to IP3
86.
Which of the following is an inhaled agent that improves V/Q mis-match in PPH
a)
Nitric Oxide
b)
Nitrus Oxide
c)
Nitrogen Oxide
d)
Sevoflurane
87.
What is the rate of infusion for Sodium Nitroprusside? What rate should avoid?
a)
0.3-0.6 mcg/kg/min; 0.6 mcg/kg.min
b)
0.3-15 mcg/kg/min; 20 mcg/kg/min
c)
0.3- 10 mcg/kg/min; >2 mcg/kg/min
d)
2-6 mcg/kg/min; 5 mcg/
88.
All of the following are systemic effect of sodium nitroprusside except?
a)
Reflex tachycardia, increased contractility
b)
Decreased renal function, release of renin as response to drop in BP
c)
Attenuates hypoxic pulmonary vasoconstriction
d)
Decreases blood flow to the cerebral arteries
89.
What is the dose of hydralazine and what is the onset?
a)
5-20 mg; 35 minutes
b)
5-20 mg; 15 minutes
c)
1-2 mg; 15minutes
d)
10-35 mg; 15 minutes
90.
What is a potent venodilator and assists with angina pectoris
a)
Nicardipine
b)
Esmolol
c)
Nitroglycerin
d)
Sodium Nitroprusside
91.
True or false: local anesthetic structure -activity relationship relies on: onset pKa; potency is length of chain and lipophilicity; Duration is protein binding
a)
True
b)
False
100 %
